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Öğe Approach to Acute Iron Intoxication: A Case Report(Galenos Yayincilik, 2011) Ozgul, Ulku; Erdogan, Mehmet Ali; Gedik, Ender; Ucar, Muharrem; Aydogan, Mustafa Said; Togal, TurkanIn adults, the main causes of iron poisoning are intake suicide attempts and an overdose of iron during pregnancy. The severity of intoxication depends on the amount of iron. When serum iron level exceeds the iron binding capacity of the body, free radicals occurs, leading to lipid peroxidation and cellular membrane damage. In iron poisoning, especially the liver, heart, kidney, lung, and hematologic systems are affected negatively. Acute iron poisoning can cause serious complications resulting in death. Clinical, laboratory observation and early treatment are important. In this case report, we examined to approach the acute iron poisoning with the occasion of high-dose iron intake for suicide attempt.Öğe Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization(Elsevier Brazil, 2017) Akdogan, Ozlem; Ersoy, Yasemin; Kuzucu, Cigdem; Gedik, Ender; Togal, Turkan; Yetkin, FundaThe effectiveness of prevention bundles on the occurrence and mortality of ventilator associated pneumonia (VAP) was evaluated in many studies. However, the effectiveness of endotracheal tube with subglottic secretion drainage (ETT-SD) and cuff pressure monitorization in VAP bundles have not been adequately assessed. In this study, we aimed to evaluate the effectiveness of VAP bundle containing ETT-SD and cuff pressure monitorization. This was a prospective, controlled study that was carried out between March 2011 and April 2012 including intubated patients. The study was conducted at the Anesthesiology Intensive Care Unit 1 and 2 (10 beds each) in a 898-bed university hospital. Occurrence of VAP and compliance with the parameters of the VAP prevention bundles were assessed daily. Patients intubated with the standard endotracheal tube were recruited as controls, mainly in the first six months of the study as ETT-SD and cuff pressure monometer had not yet been implemented. In the second term, patients intubated with ETT-SD were included as cases. Occurrence of VAP, mortality, and compliance with VAP prevention bundles were monitored. A total of 133 patients, 37 cases and 96 controls were recruited. VAP incidence declined from 40.82 to 22.16 per 1000 ventilator days among controls and cases, respectively (p < 005). On average, VAP occurred 17.33 +/- 21.09 days in the case group and 10.43 +/- 7.83 days in the control group (p = 0.04). However, mortality of cases and controls at the 14th and 30th days was not different. VAP prevention bundles including the utilization of ETT-SD, monitoring cuff pressure, and oral care with chlorhexidine were efficient in reducing the rate of VAP. (C) 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda.Öğe Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle thatcontains endotracheal tube with subglottic drainage and cuff pressure monitorization(Elsevıer brazıl, r sete setembro, 111-16, rıo de janeıro, rj 20050-006, brazıl, 2017) Akdogan, Ozlem; Ersoy, Yasemin; Kuzucu, Cigdem; Gedik, Ender; Togal, Turkan; Yetkin, FundaThe effectiveness of prevention bundles on the occurrence and mortality of ventilator associated pneumonia (VAP) was evaluated in many studies. However, the effectiveness of endotracheal tube with subglottic secretion drainage (ETT-SD) and cuff pressure monitorization in VAP bundles have not been adequately assessed. In this study, we aimed to evaluate the effectiveness of VAP bundle containing ETT-SD and cuff pressure monitorization. This was a prospective, controlled study that was carried out between March 2011 and April 2012 including intubated patients. The study was conducted at the Anesthesiology Intensive Care Unit 1 and 2 (10 beds each) in a 898-bed university hospital. Occurrence of VAP and compliance with the parameters of the VAP prevention bundles were assessed daily. Patients intubated with the standard endotracheal tube were recruited as controls, mainly in the first six months of the study as ETT-SD and cuff pressure monometer had not yet been implemented. In the second term, patients intubated with ETT-SD were included as cases. Occurrence of VAP, mortality, and compliance with VAP prevention bundles were monitored. A total of 133 patients, 37 cases and 96 controls were recruited. VAP incidence declined from 40.82 to 22.16 per 1000 ventilator days among controls and cases, respectively (p < 005). On average, VAP occurred 17.33 +/- 21.09 days in the case group and 10.43 +/- 7.83 days in the control group (p = 0.04). However, mortality of cases and controls at the 14th and 30th days was not different. VAP prevention bundles including the utilization of ETT-SD, monitoring cuff pressure, and oral care with chlorhexidine were efficient in reducing the rate of VAP. (C) 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda.Öğe The effect of plasmapheresis therapy on management of patients with snakebite(2023) Bıcakcıoğlu, Murat; Kalkan, Serkan; Doğan, Zafer; Togal, Turkan; Yucel, Neslihan; Demircan, Selcuk; Duzenci, DeccaneAim: The aim of the study was to evaluate the effectiveness of plasmapheresis therapy in patients with snakebite who were admitted to intensive care unit in the setting of tertiary referral hospital. Materials and Methods: The retrospective study involved 114 adult patients with snakebite who were admitted to a referral hospital’s intensive care unit between January 2012 and December 2022. The patients were divided into four groups according to the treatments. Group AV performed antivenom (Group AV) alone. Group PP performed plasmapheresis alone. Group AV+PP performed antivenom and plasmapheresis. Group GST performed only general supportive therapy. Results: Fifty two of 114 were included in Group GST, 31 in Group AV, 18 in Group PP and 13 in Group AV+PP. APACHE score, SOFA score, GCS, stage of the bite, length of stay in the intensive care unit, acute kidney injury, and hematological disorders were higher while the platelet count at admission was lower in Group PP and Group AV+PP compared to Group AV and Group GST (p< 0.05). Conclusion: Antivenom and plasmapheresis are not alternatives to each other, antivenom should be performed to patients according to the severity of the bite, and plasmapheresis should be performed without delay in those with severe hematological effects.Öğe The effects of cognitive impairment on anaesthetic requirement in the elderly(Lippincott Williams & Wilkins, 2012) Erdogan, Mehmet A.; Demirbilek, Semra; Erdil, Feray; Aydogan, Mustafa S.; Ozturk, Erdogan; Togal, Turkan; Ersoy, Mehmet O.Context Patients with dementia have a lower bispectral index score (BIS) when awake than age-matched healthy controls. Objectives The primary aim was to compare the BIS and the dose of propofol required for induction in patients suffering from cognitive impairment with that in those who had normal cognitive function. This study also evaluated the effects of cognitive impairment in the elderly on anaesthetic agent consumption during surgery and on emergence from anaesthesia. Design and setting This randomised controlled study was carried out in a university hospital. Patients over 65 years of age, ASA I-II and scheduled for elective orthopaedic procedures were allocated to one of two groups. Interventions Patients (n = 92) were allocated according to their Mini Mental State Examination score: 25 or higher (group 1) or 21 or less (group 2). All patients received propofol 0.5 mgkg(-1) following the commencement of a remifentanil infusion at 0.5 mu gkg(-1) min(-1). After incremental doses of propofol up to loss of consciousness, a propofol infusion was started at 75 mu gkg(-1) min(-1). Propofol and remifentanil infusion doses were adjusted to keep the BIS value between 45 and 60 during surgery. Main outcome measure MMSE score was evaluated 24 h before and after surgery. The anaesthetic consumption, mean arterial pressure, HR and BIS values of the patients were recorded. Results Before surgery, mean Mini Mental State Examination scores were 26.8 +/- 1.6 and 16.6 +/- 4.2 in group 1 and 2, respectively. These returned to baseline value 24 h after surgery in group 1 (26.6 +/- 1.5) and group 2 (15.6 +/- 4.3). Before induction, four of 45 patients (8.9%) in group 1 had a BIS value less than 93 compared with 13 of 47 (27.7%) in group 2 (P = 0.02). The mean BIS value was significantly lower in group 2 than in group 1 before induction, during loss of consciousness, 3 and 5 min after discontinuation of the anaesthetic agents and before extubation (P < 0.05). The induction dose of propofol was lower in group 2 than in group 1 (P = 0.02). The eye opening time was significantly longer in group 2 than in group 1 (P = 0.03). Conclusion The baseline BIS value was lower in patients with cognitive impairment than in those with normal cognitive function. The former received less propofol during induction and eye opening time was longer. On the basis of our findings from the recovery period, we suggest that the recommended target BIS value for adequate anaesthesia in the general population is inappropriate for patients with cognitive impairment. Eur J Anaesthesiol 2012; 29:326-331Öğe The effects of iron deficiency on red blood cell transfusion requirements in non-bleeding critically ill patients(Allied Acad, 2016) Aydogan, Mustafa Said; Ucar, Muharrem; Yucel, Aytac; Karakas, Bugra; Gok, Abdullah; Togal, TurkanIntroduction: Critically ill patients often need blood transfusion, but no reliable predictors of transfusion requirements are available at Intensive Care Unit (ICU) admission. We hypothesized that ICU patients admitted with Iron Deficiency (ID) may be at higher risk for developing anemia, requiring blood transfusion. The aims of this study were to determine the frequency of ID in ICU patients admission and to investigate its relationship with transfusion requirements in ICU patients. Methods: Two hundred ninety-six patients admitted to the general ICU were enrolled in the prospective observational study. We studied 268 patients, after excluding those transfused on or before ICU admission. The patients recorded age, gender, diagnosis, severity scores, presence of sepsis, ICU complications, ICU treatments, and transfusion-free interval. ID was assessed on the basis of several parameters, including hemoglobin, hematocrit, levels of serum iron, transferrin saturation, levels of ferritin, soluble transferrin receptor, C-reactive protein. Results: The mean age was 48 years. Of 268 patients (138 male/130 female), 114 (42.8%) had ID with outcomes of blood samples were used at ICU admission. The overall transfusion rate was 38.8%, being higher in ID patients than in normal iron profile patients (40.3 vs. 18.9%, P= 0.001). After adjusting for severity of illness and hemoglobin level, ID patients remained significantly associated with transfusion, with a hazard ratio of 5.3 (95% CI, 1.8-14.8; P= 0.001). Conclusion: ID is common at ICU admission and is associated with higher transfusion requirements. These findings have important implications for transfusion practices for in ICU patients.Öğe Effects of sample temperature and storage time on arterial blood gases values(Drunpp-Sarajevo, 2012) Aydogan, Mustafa Said; Yucel, Aytac; Erdogan, Mehmet Ali; Sanli, Mukadder; Konur, Huseyin; Ozgul, Ulku; Togal, TurkanBackground: Arterial blood gas analysis is vital during diagnosis and treatment monitorization of mechanically ventilated patients. Work overload delays blood gas analysis lead to false results. Therefore syringes and the blood samples is recommended to kept cool or cold environment. The aim of this study is to investigate the effect of refrigerator-cooled syringes on blood gas analysis. Methods: We prepared 12 heparinized polypropylene plastic syringes for blood gas analysis for each patients before the study. Syringes divided in tree group as kept at room temperature (Group Room, n=4), or stored in the refrigerator for 30 minutes (Group Refrigerator, n=4), or stored in the refrigerator for 30 minutes but blood samples stored at room temperature (Group Refrigerator and Room, n=4). 40 for each patient's blood samples on mechanical ventilation were analyzed immediately as reference value (T-0). Samples analyzed at 15, 30, 45 and 60 minutes. Results: Patients characteristics and mechanical ventilation parameters were similar in the three groups. In terms of impact of sample temperature and storage time on arterial blood gas analysis; pH, pCO(2), and pO(2) values were not differ significantly among the groups (Table 2, P>0.05). There was significant difference in 60 minutes SpO(2) value among the groups (Table 2, P<0.05). Conclusion: Storage of syringes at room temperature or cooling in refrigerator was not affect arterial blood gas analysis results immediately before obtaining of blood samples. Blood gas analysis with plastic syringes at room temperature can provide safe results up to 60 minutes.Öğe Fat Embolism Syndrome in Two Cases with Multiple Fractures(Galenos Yayincilik, 2012) Ozgul, Ulku; Gedik, Ender; Karakaplan, Mustafa; Koc, Elif; Koca, Erdinc; Togal, Turkan; Ersoy, Mehmet OzcanFat embolism is a syndrome which is caused by oil particles introduce into the systemic circulation and consists of respiratory distress, altered consciousness and petechial rashes. It may occur following traumatic, surgical and non-traumatic clinical conditions. The most common occurrence develops following the long bone fractures within 24-72 hours. The clinical picture of syndrome may vary slightly condition as well as respiratory failure and coma. The diagnosis is done based on mostly clinical criteria. There is no specific laboratory and radiographic findings. The suggested supportive approaches in the treatment of this syndrome are early fixation of the fracture, maintenance of fluid and electrolyte balance and treatment of hypoxia. We aimed to present two cases of successful diagnosis and treatment process with fat embolism syndrome following multiple fractures due to in-vehicle traffic accidents.Öğe A Heart Transplant Recipient Lost Due to Pneumocystis jiroveci Pneumonia Under Trimethoprim-Sulfamethoxazole Prophylaxis: Case Report(Baskent Univ, 2010) Celik, Tuncay; Gedik, Ender; Kayabas, Uner; Bayindir, Yasar; Gulbas, Gazi; Firat, Ahmet Kemal; Togal, TurkanInfections in solid-organ transplant recipients are the most important causes of morbidity and mortality. A primary goal in organ transplant is the prevention or effective treatment of infection, which is the most-common life-threatening complication of long-term immunosuppressive therapy. A 21-year-old woman who underwent heart transplant 3 years previous owing to dilated cardiomyopathy was referred to our hospital with symptoms of high fever and cough. The patient's history revealed that she had received a trimethoprim-sulfamethoxazole double-strength tablet each day for prophylactic purposes. On chest radiograph, pneumonia was detected, and in broncho-alveolar lavage sample, Pneumocystis jiroveci cysts were found. After diagnosing P. jiroveci pneumonia, trimethoprim-sulfamethoxazole was initiated at 20 mg/kg/d including intravenous trimethoprim in divided dosages every 6 hours. On the sixth day of therapy, she died in intensive care unit. In solid-organ transplant recipients, although antipneumocystis prophylaxis is recommended within the first 6 to 12 months after transplant, lifelong prophylaxis is also used in several settings. In addition, the physician should keep in mind that P. jiroveci pneumonia may develop in solid organ recipients, despite trimethoprim-sulfamethoxazole prophylaxis.Öğe Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital(Taylor & Francis Inc, 2017) Gedik, Ender; Yucel, Neslihan; Sahin, Taylan; Koca, Erdinc; Colak, Yusuf Ziya; Togal, TurkanPurpose: The aim was to assess outcomes for pregnancies in which hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome develops and the patient requires transfer for critical care. Materials and Methods: The cases of women with HELLP syndrome who delivered at our tertiary center or surrounding hospitals and were admitted to the intensive care between January 2007 and July 2012 were retrospectively analyzed. Results were compared for the surviving and non-surviving patients. Results: Among the 77 women with HELLP syndrome, maternal mortality rate was 14% and 24 (30%) of 81 fetuses and newborns died in the perinatal period. The most common maternal complications were disseminated intravascular coagulation (DIC) (n = 22; 29%), acute renal failure (n = 19; 25%), and postpartum hemorrhage (n = 16; 21%). Compared with surviving women, the non-surviving women had higher mean international normalized ratio (INR) (p < 0.0001); higher mean serum levels of aspartate aminotransferase (AST) (p < 0.0001); higher alanine aminotransferase (ALT) (p < 0.0001); higher lactate dehydrogenase (LDH) (p < 0.0001), and higher bilirubin (p = 0.040) levels; and lower platelet count (p = 0.005). Conclusion: DIC is a major risk factor for maternal outcome among patients with HELLP syndrome who require intensive care. Low platelet count; high AST, ALT, LDH, INR; and total bilirubin are associated with high mortality risk in this patient group. In addition, low platelet count; low fibrinogen level; prolonged activated thromboplastin time; high INR; and high total bilirubin, LDH, blood urea nitrogen, and creatinine are associated with high risk for complications in this patient group.Öğe Is airborne transmission of Acinetobacter baumannii possible: A prospective molecular epidemiologic study in a tertiary care hospital(Mosby-Elsevier, 2016) Yakupogullari, Yusuf; Otlu, Baris; Ersoy, Yasemin; Kuzucu, Cigdem; Bayindir, Yasar; Kayabas, Uner; Togal, TurkanBackground: Understanding the dynamics of aerial spread of Acinetobacter may provide useful information for production of effective control measurements. We investigated genetic relationships between air and clinical isolates of Acinetobacter baumannii in an intensive care unit (ICU) setting. Methods: We conducted a prospective surveillance study in a tertiary care hospital for 8 months. A total of 186 air samples were taken from 2 ICUs. Clonal characteristics of air isolates were compared with the prospective clinical strains and the previously isolated strains of ICU patients over a 23-month period. Results: Twenty-six (11.4%) air samples yielded A baumannii, of which 24 (92.3%) isolateswere carbapenemresistant. The Acinetobacter concentrationwas the highest in bedside sampling areas of infected patients (0.39 CFU/m(3)). Air isolateswere clustered in 13 genotypes, and 7 genotypes (including 18 air strains) were clonally related to the clinical strains of 9 ICU patients. One clone continued to be cultured over 27 days in ICU air, and air isolates could be clonally related to 7-week retrospective and approximately 15-week prospective clinical strains. Conclusions: The results of this study suggest that infected patients could spread significant amounts of Acinetobacter to ICU air. These strains could survive in air for some weeks and could likely still infect new patients after some months. Special control measurements may be required against the airborne spread of Acinetobacter in ICUs. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.Öğe The major clinical determinants of maternal death among obstetric near-miss patients: a tertiary centre experience(Pakistan Medical Assoc, 2013) Simsek, Yavuz; Yilmaz, Ercan; Celik, Ebru; Aydogan, Mustfa Salt; Celik, Onder; Togal, TurkanObjective: To evaluate the characteristics of obstetric near-miss patients to clarify the major risk factors of maternal mortality. Methods: From among the patients referred to the Department of Obstetrics and Gynaecology, Inonu University of Medical Sciences, Turkey, between August 1, 2010 and March 1, 2012, electronic records of obstetric near-miss cases were retrospectively analysed. The obstetric and demographic characteristics of cases that were successfully treated (Group 1) as well as cases with maternal death (Group 2) were analysed and compared. SPSS 11.5 was used for statistical analysis. Results: Of the total 2687 cases handled during the study period, 95 (3.53%) were of the near-miss nature. The most frequently encountered underlying aetiology was severe preeclampsia (n=55; 57.89%) and haemolysis, elevated liver enzymes, low platelet count syndrome (n=20; 21.1%). These were followed by cases of postpartum bleeding (n=18; 18.9%). Maternal mortality occurred in 10 (10.5%) patients, representing Group 2. The amount of haemorrhage and blood transfused were significantly higher in the group. Maternal mortality cases had also significantly longer duration of intensive care unit admission. Conclusion: Early diagnosis and immediate management of the complications noted by the study can be the most important measures to prevent the occurrence of mortality.Öğe Obstetric admissions to the intensive care unit in a tertiary referral hospital(W B Saunders Co-Elsevier Inc, 2010) Togal, Turkan; Yucel, Neslihan; Gedik, Ender; Gulhas, Nurcin; Toprak, H. Ilksen; Ersoy, M. OzcanPurpose The present study was conducted to evaluate the obstetric admissions to the intensive care unit (ICU) in the setting of a tertiary referral hospital in an attempt to identify the risk factors influencing maternal outcome Materials and Methods All of the obstetric patients who seeked care for delivery at the emergency department and who were admitted to the ICU between January 2006 to July 2009 were retrospectively identified The Simplified Acute Physiology Score (SAPS II) was calculated and the maternal mortality rate was estimated for each patient The mean SAPS II scores and the mean estimated maternal mortality rates for the surviving patients and the nonsurviving patients were compared Results Seventy-three obstetric patients were admitted to the ICU There were 9 maternal deaths and 24 fetal deaths For the surviving group of patients, the mean SAPS II score was 34 and estimated maternal mortality rate was 20%, whereas for the nonsurviving group of patients the SAPS II score was 64 and estimated maternal mortality rate was 73% The difference between the surviving group of patients and the nonsurviving group of patients was statistically significant regarding both the mean SAPS II scores and the mean estimated maternal mortality rates Conclusions Pregnancy induced hypertensive disorders and hemorrhage appear as the major risk factors influencing maternal outcome in obstetric patients Considering that the use of the SAPS II scores have enabled the reliable estimation of the mortality rates in the present study, the attempts at defining the focus of care for the obstetric patients who bear the major risk factors and who are admitted to the ICU should be carried out under the guidance of the ICU scoring systems such as the SAPS 11 (C) 2010 Elsevier Inc All rights reservedÖğe Pain, fentanyl consumption, and delirium in adolescents after scoliosis surgery: dexmedetomidine vs midazolam(Wiley-Blackwell, 2013) Aydogan, Mustafa S.; Korkmaz, Mehmet F.; Ozgul, Ulku; Erdogan, Mehmet A.; Yucel, Aytac; Karaman, Abdurrahman; Togal, TurkanBackground The study aim was to compare the efficacy of dexmedetomidine vs midazolam for sedation during the early postoperative period in adolescents who underwent scoliosis surgery. Methods We performed a prospective, randomized trial in an intensive care unit (ICU) in a tertiary care center. In this study, 42 patients (American Society of Anesthesiology physical status I and II) who underwent scoliosis surgery were divided into two groups according to sedation protocols: group dexmedetomidine (DEX) (n=22) and group midazolam (MDZ) (n=20). Adolescents (1218years) requiring mechanical ventilation underwent a continuous infusion of either dexmedetomidine (group DEX; starting dose, 0.4g center dot kg1 center dot h1) or midazolam (group MDZ; starting dose, 0.1mg center dot kg1 center dot h1) with intermittent fentanyl, as needed. The efficacy of sedation was assessed using the Richmond Agitation Sedation Scale (RASS). Quality of pain relief was measured using the Numeric Visual Analog Scale (NVAS). Delirium was determined in patients in the RASS range of 2 to +1 using the Confusion Assessment Method for the ICU (CAM-ICU). Fentanyl consumption, incidence of delirium, NVAS scores, and hemodynamics were recorded postoperatively at 2, 4, 6, and 24h in the ICU. Results The NVAS pain scores and fentanyl consumption at all the evaluation time points were significantly higher in group MDZ than those in group DEX (P<0.05). Further, total fentanyl consumption in group MDZ was significantly higher than that in group DEX (P<0.05). Delirium was significantly higher in the group MDZ than that in group DEX (31.3% vs 12.5%) when analyzed as the endpoint of CAM-ICU (P<0.05). The heart rate was significantly lower in group DEX compared with that in group MDZ at all the evaluation time points (P<0.05). Conclusion Dexmedetomidine was associated with the decreased postoperative fentanyl consumption, NVAS scores, and a decreased incidence of delirium. These findings may be beneficial for managing sedation protocols in adolescents who have undergone scoliosis surgery.Öğe Retrospective Analysis of Intoxication Patients Admitted to Intensive Care Unit: Evidence Based Management vs Personal Experience(Drunpp-Sarajevo, 2011) Ertan, Cem; Gedik, Ender; Yucel, Neslihan; Akgun, F. Sinem; Aslan, Sibel; Togal, Turkan; Ersoy, M. OzcanObjective: Intoxication is a major problem in emergency departments (ED). Patients shall either be hospitalized or discharged after ED care. This decision requires a thorough evaluation of the patients' risk of mortality and cost effective approach. Aim of this study was to define characteristics of our poisoning patients and appropriateness of their hospitalization decisions to ICU. Methods: Adult patients hospitalized to ICU following admittance to ED within three years period with acute poisoning were retrospectively enrolled. Demographics, poisoning data, former psychiatric history, ICU follow up information, outcome at hospital discharge and in the first 28 days and predominant pathological clinical findings were recorded. Results: Our study group accounted for 3.6 per 1000 ED visits and 16.6% of ICU admittance. Mean age of the patients was 30.21 +/- 12.83 years, F/M ratio was 2.2 and 48.9% of the patients were married. Foremost encountered substances were psychoactive drugs (39.4%). 94.2% of our patients were suicidal and 39.8% of them used two or more agents. Intubation and mechanical ventilation was performed for 14 patients (5.1%), mean duration for intubated follow up was 7.07 days. Only two patients with caustic ingestions were dead (0.8%). Mean hospitalization period was 4.78 +/- 8.77 days and mean ICU bed use was 2.62 +/- 3.18 days. Total hospitalization duration was <= 48 hours 198 (72.3%) patients and > 48 hours in 76 patients (27.7%). Conclusion: We speculate that, high rates of early discharge from ICU may support the necessity of a solid ICU admission criterion.Öğe Sezaryen sonrası eklampsiyle ilişkili ani görme kaybı: Olgu sunumu(2013) Erdoğan, Mehmet Ali; Aydoğan, Mustafa Said; Özgül, Ülkü; Konur, Hüseyin; Demiröz Aslan, Duygu; Gedik, Ender; Togal, TurkanÖz: ÖZET Preeklampsi; gebeliğin ikinci yarısından sonra görülen, hipertansiyon ve proteinüri ile karakterize gebeliğe özgü bir bozukluktur. Tonik-klonik nöbet oluşturarak beynin etkilenmesiyle eklampsi formu oluşur. Eklampsi hafif preeklampsilerin %0.5inde, ağır preeklampsilerin ise %2 ile %3ünde görülmektedir. Preeklampsi ve eklampsi görmede azalma, fotopsi ve görme alanı defektleri gibi semptomları oluşmaktadır. Şiddetli preeklampside gebelerin %25inde görme bozuklukları meydana gelirken, eklampside gebelerin %1 ile %2sinde körlük bildirilmiştir ve nerdeyse tamamında geçici bir fenomendir. Ani görme bozukluğu veya körlük önceden sağlıklı olan bir birey için oldukça korkutucu ve endişe vericidir. Neyse ki klinik (fetusun ve plesantanın doğurtulması gibi) ve laboratuar değerlerin düzeltilmesiyle günler içinde tamamen iyileşmektedir. Titiz bir öykü ile nörolojik ve oftalmik muayene, hasta ve yakınlarına pozitif destek ile güven verilmesi büyük önem taşmaktadır. Bu sunumda, eklampsi nedeniyle acil sezaryen yapılan, bilateral kortikal görme kaybı olan olgunun yoğun bakımdaki klinik seyrini sunmayı amaçladık.Öğe Thromboelastographic comparison of the effects of different fluid preloading regimens delivered before spinal anesthesia(Drunpp-Sarajevo, 2012) Ozen, Irsat; Togal, Turkan; Aydogan, Mustafa Said; Erdogan, Mehmet Ali; Nakir, Hamza; Gulhas, Nurcin; Toprak, Huseyin IlksenIntroduction: Various fluids used for preloading purposes prior to spinal anesthesia. Coagulation disorders can occur due to use of those fluids at large volumes [1]. We aimed to compare the impact of different preloading fluids over coagulation parameters. Method: Sixty-eight patients of ASA I-II physical status who were aged between 18 and 75 years, and scheduled for orthopedic surgery under spinal anesthesia, were included in the study. Prior to the spinal anesthesia, preloading was carried out by RL in Group R (n=16), HES (130/0.4) in Group H (n=16), polygeline in Group P (n=16), and succinylated gelatin 7 ml/kg in Group S (n=16). RL was used as the maintenance fluid in all the groups. Thromboelastography, CBC, PTT, aPTT, fibrinogen values were assessed at baseline and 2 hours. Results: Groups P and S displayed significantly prolonged PTT values. While Groups R and P showed significantly prolonged PTT-INR values, groups R and H exhibited significantly prolonged aPTT values. Groups R, P, and S demonstrated significant decreases in TEG parameters including R, K, CI, and TMA. The increase in a angle was significant in groups R and S. Conclusion: Fluid preloading with HES was not found to affect the coagulation parameters, however, polygeline and succinylated gelatin were observed to cause moderate hypercoagulation. Therefore, we believe that HES may be preferred over succinylated gelatin and polygeline in cases with hypercoagulability.Öğe The Use of Noninvasive Mechanical Ventilation in Myasthenic Crisis(Galenos Yayincilik, 2012) Aydogan, M. Said; Erdogan, M. Ali; Yucel, Aytac; Ozgul, Ulku; Konur, Huseyin; Togal, Turkan; Durmus, MahmutMyasthenia gravis is an autoimmune disease of the nicotinic acetylcholin receptors at the postsynaptic membrane of the neuromuscular junction. Myasthenic crisis, defined as respiratory failure requiring mechanical ventilation is a common life-threatening complication that occur approximately 15% to 20% of patients with MG. Endotracheal intubation and invasive mechanical ventilation have a number of complications and a high mortality. On the other hand, noninvasive mechanical ventilation is being successfully used in many pulmonary and neuromuscular diseases. There are few reports about the use of noninvasive mechanical ventilation in myasthenic crisis. We present a case with myasthenic crisis who was treated with noninvasive mechanical ventilation.
